Torture Survivors in Analytic Therapy

Jung, Politics, Culture

Monica Luci

• Publisher: Routledge
• Year: 2022
• Print ISBN: 9780367426682
• eBook ISBN: 9781000583687
• Topic: Psychology
• Subtopic: Movements in Psychology
• Index: Psychology

This important new book introduces and discusses the underpinning of psychodynamic psychotherapy for torture survivors in a clinical setting and incorporates concepts from analytical psychology and other theoretical bases in order to provide readers with a deeper understanding of this complex trauma.

Using the concepts of analytical psychology, relational psychoanalysis, and neuroscience, and relying on the theoretical basis of her book Torture, Psychoanalysis and Human Rights (Routledge, 2017), Luci focuses on three key clinical cases and illustrates the therapeutic paths that the therapeutic dyad explore and experiences in order to get out of the patient's inner prison created or aggravated by the experience of torture. The book discusses the role of the therapist when working with torture survivors, the requirement of a slow and cautious approach when dealing with such trauma, and the importance of a careful and respectful consideration of issues of identity, politics, and culture.

Featuring a useful guide, this book will be of great interest to mental health professionals, psychotherapists and students practicing in services that provide assistance to torture and war trauma survivors.

1 The Role of the Body in the Therapy of Torture Survivors

DOI: 10.4324/9780367854294-2

Thinking of the body in therapy is a true challenge for any psychoanalyst. It is structurally difficult to think of one’s own foundations, the matter that is the source of psychic life. With innovative insight, in Spirit and Life, Jung writes that the difference between body and psyche is only epistemological, not ontological, except because we have unjustly attributed it to an independent existence (1926: para. 619). Jung comments on a picture drawn by a patient:

The tree symbolizes earthbound corporeality, the snake emotionality and the possession of a soul. Without the soul, the body is dead, and without the body the soul is unreal. The union of the two, which is plainly imminent in this picture, would mean the animation of the body and the materialization of the soul.

(Jung, 1954: para. 316)

Elsewhere, he compares the archetype to the physiological instinct: “In archetypal conceptions and instinctual perceptions, spirit and matter confront one another on the psychic plane” (Jung, 1947: para. 420). He points out three essentially distinguishing features of spirit that are very interesting for what will be expressed through the following clinical case: “The hallmarks of spirit are, firstly, the principle of spontaneous movement and activity; secondly, the spontaneous capacity to produce images independently of sense perception; and thirdly, the autonomous and sovereign manipulation of these images” (Jung, 1948: para. 393).

Clinical Case: Adina

Adina is 35 years old when we meet at the Post Traumatic Stress Disorder outpatient service of a main Italian hospital. She is a refugee and has been living in Italy for the last 10 years. She has an asylum permit and works as household help and in the care of old people. Adina is of mixed origin: her father is Eritrean and her mother is Ethiopian. She grew up in an Ethiopian town with her mother, a nurse, and her grandmother. Her father disappeared when she was about two years old. She has no memories of him and few childhood memories in general. She did not ask about him, and her mother was not forthcoming with their story. Adina is convinced that she had a warm and nurturing environment around her and could grow up healthy and strong thanks to the women of the family. She completed secondary school and graduated as a secretary, working for a short time in a company office.

At the age of 22, she was seized during the war and tortured and raped in alternate episodes by Ethiopian and Eritrean groups because of her mixed origins. In addition, during the last episode of violence, she was kept for about four months in a prison-house and tied to a chair in a painful position for weeks. With deep grief and pervasive shame, she described then being dumped on the roadside “like waste material.” Rescued by a farmer, she spent over a month in the hospital due to multiple bone fractures, and then she fled toward Europe, applying for asylum in Italy. Today, she is a refugee. About a decade after the traumatic events, she arrived in therapy still suffering from a Complex Post Traumatic Stress Disorder multiple physical problems, and severe alexithymia. She perceives her body as divided in half by pain and paresthesia of uncertain origin.

The Struggle With Silence and Dis-Ownership of the Body

At our first meeting, a co-joint meeting with a physician, an overweight Adina enters the office with a gentle smiling face. She holds a big folder containing the results of all her analyses and medical exams. She wants to find a solution for serious and chronic pain and paresthesia at legs and arms due to mutiple problems at her spine. The extensive medical documentation demonstrates her compulsive search for medical care and how she understands her suffering only from a physical perspective. A surgeon has recently proposed spine surgery.

The physician and I have a countertransferential phantasy that Adina is slowly sliding toward an irreversible physical condition if we are not responding promptly and differently than treating her body. After some reflection, we decide to offer her psychodynamic psychotherapy in addition to medical treatment to open a possibility of reflection on her physical state. She very willingly accepts.

Her once-per-week therapy develops like a struggle of the therapeutic dyad to find words for her unspeakable terrors and pains. Since the initial meetings, it is clear that Adina suffers from chronic depressed mood, alterations in self-perception and her perception of others, many and intense somatizations, avoidance of intimate relationships, and an altered system of meaning after trauma. After 10 years, she still suffers from nightmares referred to as her trauma and seems to suffer from Complex PTSD in which dissociation, somatizations, and a series of personality changes are prevalent. Apparently attentive and sensitive to the other, she seems totally unable to talk about herself and her emotions. She also complains of a pervasive feeling of emptiness, a sense of estrangement from herself and the world, and deep sadness in her daily life. She perceives herself as permanently changed, unable to have a normal life, with a marked destiny, although she cannot explain what she exactly means by that.

The therapy starts with Adina’s prolonged silences. She provides some information about her life and traumatic experiences. It seems impossible to add more significant information or go deeper into her story. For months, the therapy proceeds with a sense of frustrating meaninglessness of verbal exchanges between us. The explicit content of our sessions sounds empty and dry, with no soul. The true content seems to be an alternate rhythm between prolonged and frustrating silences and her complaints about bodily pain.

Complex Post Traumatic Stress Disorder often involves such a dispossession of the body. There is no longer an “owner” (Yochai, 2018). In Adina, the self is so disjointed that it lacks sufficient organization to allow the ego, which is also there, to recognize itself and to orient intention and conscious action in coordination with the self.

Jung always emphasized the absurd littleness of the ego in the face of the cosmic infinity of self, which “dwarfs the ego in scope and intensity” (Jung, 1947: para. 430). However, the ego was also seen to be the center of the process of individuation, its activity being crucial to the realization of the self. In massive trauma, the inconsistency or fragmentation of self becomes crucial to the functioning of the ego.

Neuroscience increasingly suggests that our sense of inhabiting a body does not come from our cognition or emotional experiences but from visceral sensations and sensory-motor perceptions (Damasio, 1999; Van der Kolk, 2014: 311–312; Alcaro et al., 2017). Concepts elaborated in neuroscientific works, such as Panksepp’s (2005) concept of the “core self,” Damasio’s (2010) “proto-self,” and Schore’s (2011a) “implicit self,” refer to a network of largely subcortical structures responsible for primal affective experiences and their concomitant motor response organization. This means that the self is rooted in our body and connected to brain structures. These structures come before, phylogenetically and ontogenetically, those responsible for emotion and cognition. For Jung, mind–body dualism is due to the limits of the human intellect, forcing us to dichotomize reality in order to know it, but “psyche and matter are two different aspects of one and the same thing” (Jung, 1926: para. 418).

However, traumas interrupt this continuity, and thus traumatized people have difficultly perceiving what is going on in their body, which is why they do not have varied emotional responses to frustration and tend to react to stress with dissociation, anxiety, or excessive anger. This failure of contact with one’s body contributes not only to the lack of self-protective ability and the high rate of re-activation but also to the considerable difficulty in experiencing pleasure and in making sense of things.

An Embodied Meeting

Adina complains massively of her physical problems, which are reported as opposites – for example, she feels cold and hot pain and paresthesia, especially in her arms and legs. During our sessions, we are immersed in this prolonged lament of physical ailments, and it is difficult for us both to remain present. Adina spends the rest of the time spaced out, gazing at nothing.

From our first encounter, I feel we are in a race against time, as if necrosis is proceeding in her body. For both of us, the feeling of emptiness, being stuck and, simultaneously, under pressure to act quickly and find relief, combine to amplify the sense of powerlessness and of being alone in utter despair. There is a sense that her body is going down the drain, becoming corrupted, and split in half: the half of her body that is burning and aching seems to be alive, while the half that is cold and anesthetized seems to be dead. The therapy is characterized by long, unbearable, frustrating, and apparently unproductive silences.

One day, four months after commencing, Adina arrives and starts the following conversation:

P: All stuck (referring to the traffic and the city)… . Even my body.

T: The surgery, too. (Before the session, she stopped me outside the room to tell me that the surgeon she had to meet to discuss her spine operation had suffered the loss of a family member and was not at work. She seems relieved. I get the impression that she is very frightened by the idea of the surgery.)
She takes off her coat.

P: It is cold outside (as if to justify her seemingly excessive layers of clothing). It arrived here, this far (describing the pain in her fingertips). I have a hard time remaining still.

T: You can move.
She stands up and starts walking

T: How do you feel?

P: I’m down.

T: Down like?

P: There is nothing inside me. Empty. I don’t know what my brain is thinking. How do they say? (she looks for the word in Italian) … in my language is “dead body.”

T: Corpse (I say in a whisper).
She cries silently (I feel guilty).

P: Why only one part feels hot, like burning? Why?

T: Since when?

P: This week. Maybe it’s moving (death).

T: Does it communicate something? Try to pay attention to that hot body part. What comes to mind?
(I am struggling to make her talk about something significant).

P: Nothing. I feel burning, hot, even pain. Also fear. For the reason why this heat came I have not found an answer yet. This left side … less pain. It’s cold. Why? That’s enough!

T: Split in half?
(She nods her head).

T: Half is . . .

P: Dead. Cold.

T: The other half is …
(I am struggling to help her find words).

P: It is walking to get here (reach the other, to death).
(She is describing a slow process of necrosis – the one we phantasized at the beginning).

T: I wonder if the idea of intervention that could be decisive for pain is something scary because the part alive is the one that hurts...

Table of contents

• Cover
• Half Title
• Series
• Title
• Copyright
• Dedication
• Contents
• Acknowledgments
• Introduction
• 1 The Role of the Body in the Therapy of Torture Survivors
• 2 Mixed Violations: Slavery and Torture
• 3 Gender-Based Violence and Torture: The Personal Is Political
• 4 Principles for the Psychotherapy of Torture Survivors
• Conclusions
• Index